Snoring and Obstructive Sleep Apnoea (OSAS)

Obstructive sleep apnoea syndrome, or OSAS, is a condition in which breathing stops during sleep, because the upper airway narrows or blocks again and again.

These pauses break the continuity of sleep. They stop the patient sleeping deeply and restfully, so the patient is very sleepy during the day.

Anyone who stops breathing for more than 10 seconds in their sleep, snores, cannot concentrate during the day and needs to doze should be examined.

What happens during sleep

The lungs are healthy in these patients. The airway closes because of the blockage higher up, and the patient cannot breathe. Snoring comes with it, and the partner wakes the patient, saying they seemed to be choking.

Apnoea means that the patient cannot breathe for at least 10 seconds. The oxygen in the blood falls and sleep is broken.

Why it matters

Drivers with sleep apnoea kill more people in traffic accidents than drunk drivers do. They cause eight times more accidents than other people.

The condition causes health problems and social problems. Snoring, pauses in breathing and daytime drowsiness are the clear signs. Breathing sometimes stops 50 to 60 times an hour. The patient wakes tired, is inattentive during the day and keeps dozing.

70 per cent of these patients are overweight, though thin people get obstructive sleep apnoea too. A sedentary life, alcohol, smoking and eating late all make it worse.

OSAS affects 8 per cent of the population. Over the age of 65, one person in four has it. It is commoner in men.

Thousands of patients in Türkiye live without a diagnosis and without proper treatment. Untreated, 25 per cent of them have a heart attack, 25 per cent have a stroke in later life and 30 per cent develop high blood pressure. OSAS prepares the ground for many serious diseases.

Apnoea in a child is a very serious, life-threatening condition. It causes problems that reach as far as sudden death in bed.

The most important condition underneath a driver falling asleep on a straight road is OSAS. Long-distance drivers should be assessed for it, because they move very little, their eating and sleeping are irregular and most of them are overweight.

Snoring is where sleep disease starts

Snoring is a social problem, and it is also the start of sleep disease. Treat it as such. If the other complaints are present, the patient needs an examination, blood tests, imaging and a sleep test in hospital overnight. Medical and surgical treatment follow from the results.

The examination

These patients are usually overweight, with a short neck and a lower jaw set slightly back.

The airway, and the nose above all, must be assessed thoroughly. Endoscopic camera systems are used to examine the mouth, the nose, the back of the nose, the base of the tongue, the vocal cords, the larynx, the soft palate, the uvula and the lower jaw in detail.

The sleep test

Polysomnography is the key test. While the patient sleeps, it records brain activity, the ECG, eye movements, the oxygen level in the blood and the airflow, continuously. Five to eight hours of recording are then assessed. If the pauses in breathing and the drops in airflow, called apnoeas and hypopnoeas, pass a certain number, obstructive sleep apnoea is diagnosed.

Medical treatment

The first advice is to lose weight, take more exercise, stop alcohol and smoking, consume nothing but water after 8 in the evening, and treat reflux if it is present.

The first medical option is CPAP, which is a mask that delivers air through the nose. The positive pressure air passing through the nose overcomes the blockage while the patient sleeps. Devices worn in the mouth stop the tongue falling back and blocking the airway, and they are used as well.

Surgical treatment

Surgery corrects the problems step by step, starting at the nose and moving to the palate, the uvula, the base of the tongue and the jaw.

In the nose, the crookedness that blocks the airway is corrected first. Very large tonsils are removed. Long-standing sinusitis and nasal polyps are treated surgically if the patient has them.

In children, the commonest cause of sleep apnoea is the tonsils and the adenoid. Removing them surgically is a very effective treatment.

Devices worn in the mouth are used in selected patients. They hold the lower jaw or the tongue forward, and they are made by dentists.

What patients should watch

1. Weight. Excess weight is the best known risk factor. Losing weight, at least 5 to 6 kg, eases the signs. Diet and a suitable exercise programme under a doctor work. Patients with severe disease develop metabolic problems and cannot lose weight despite every effort. Patients who do lose weight put it back on quickly unless they change how they live.
2. Sleeping tablets. They increase how often the pauses come and how long they last. If you need them, take them only under a doctor.
3. Position. In about half of patients the pauses increase when they lie on their back. In some, snoring and pauses happen only on the back. Measures that stop them lying on their back, such as pillows behind them or a tennis ball in their pyjamas, can solve the problem.
4. A blocked nose. Conditions that block the nose increase snoring by 10 to 15 per cent. Treating them reduces snoring and irregular breathing during sleep to some degree. Clearing the nose is also an important help in getting the patient to tolerate CPAP.